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Scaling the Supply Chain: Perspectives from Academic Medical Centers
Session #SC5 February 11, 2019
Academic Medical Cen
George R. Cheely, MD, MBA, DUHS Medical Director for Care Redesign
Jane Pleasants, Vice President, Supply Chain, Duke Health
Franco Sagliocca, Corporate Director, Supply Chain, Mt. Sinai Health System
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Jane Pleasants has no real or apparent conflicts of interest to
report.
George Cheely MD has no real or apparent conflicts of interest to
report.
Franco Sagliocca has no real or apparent conflicts of interest to
report.
Conflict of Interest
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Duke University Health System: Pursuit of Better Outcomes,
Lower Cost through Care Redesign and Clinical Supply Chain
Integration
– George Cheely, MD, Medical Director, Care Redesign
– Jane Pleasants, VP, Supply Chain
Mt. Sinai Health System: Building the technology and data
infrastructure to enable the Clinically Integrated Supply Chain
– Franco Sagliocca, Corporate Director, Supply Chain
Agenda
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• Identify the common elements, success points, and essential
components of the clinically integrated supply chain in an
academic medical setting
• Discuss the drivers of scale, the strategies needed to achieve the
next level, and how to maintain a scaled down version of a
clinically integrated supply chain
• Discuss the strategies needed for inter-professional collaboration
across the healthcare ecosystem to achieve shared goals
• Develop a vision for integrating the community across the care
continuum and beyond the walls of the healthcare organization
Learning Objectives
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ACA: Focus on outcomes & cost
CR Oversight Committee Selected Members
Chief Medical Officer, DUHS
Executive Vice President, DUHS
Chief Nursing Officer, DUHS
Hospital Presidents
Chief Health Information Officer, DUHS
Associate Chief Financial Officer, DUHS
VP Supply Chain, DU and DUHS
Associate VP Performance Services, DUHS
Clinical Department Chairs (Ad Hoc)
Care Redesign Oversight Committee formed
in 2011 to:
• Improve the experience of care (safety,
quality, and satisfaction)
• Improve the health of populations
• Reduce the cost of care
 Provide oversight for the Care Redesign program
 Review & approve team charters & initiatives
 Hold teams accountable to milestones & targets
 Resolve issues & remove barriers to progress
 Drive acceptance across departments & entities
 Support prioritization of implementation efforts
Care Redesign Oversight Committee
Responsibilities
Care Redesign Program Members
George Cheely, Medical Director
Tom Hopkins, Associate Medical Director
Judy Prewitt, Nursing Lead
Caitlin Daley, CR Program Manager
Improvement Facilitators
Clinical Data Analytics
Key Collaborators: Finance, Health IT,
Pharmacy, Procurement, EBM Librarians
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Analytics to Gauge Variation
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Translated clinical goals to measures
Care Redesign Organizational Goals
 Pursue care delivery innovations and advancement of quality
and safety through redesign of care for select populations
 Goals include: Quality, Patient Safety, Patient Experience,
Finance and Growth, and Patient Population-specific
measures
Outcome Measures
Avoid Extra Days in the Hospital (Length of Stay)
Reduce Unplanned Returns (30 Day Readmissions)
Improve Survival (Mortality)
Improve Experience of Care (HCAHPS)
Improve Efficient Use of Resources (Cost / Case)
Process Measures: Example Hip and Knee
 Process Metric: % patients who ambulated with physical therapy on POD
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 Quality Metric: % of patients readmitted within 30 days and 90 days
 Safety Metric: % urinary catheter’s removed POD 0
Metrics must be
relevant for a cross-
section of
stakeholders
To clinicians, who must
believe that the metric
links activities to
outcomes …
To finance, who must
ensure that expected
margin impacts are
visible on the bottom line
…
To performance
management, who must
be able to get the
information into the right
hands in a timely and
predictable way …
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Executed tactics to achieve impacts
Initiatives
Improvement Tactics
Intended
Impacts
Improve
Planning
Coordinated support needed after discharge from first clinic
visit
• Defined clinical standards to identify patients appropriate for
discharge home instead of post-acute care
Increase patients
able to be
discharged to home
Improve
Discharge
Facilitation
Multidisciplinary team optimized discharge processes
• Revised discharge instructions and care coordination tactics
to align with overall plan for care
Reduce length of
stay and
readmissions
Enhance
Patient
Experience
Developed multi
-model pain management approach
• Standardized pain management plan and integrated into
patient education materials as well as nursing care and
teaching plans
Improve satisfaction
with pain
management
Define
Implant
Standards
Coordinated clinical decisions &
contracting to reduce
variation
• Defined high cost implant usage standards based on
evidence
• Leveraged stakeholders to support vendor negotiations
Reduce implant
spend through
utilization and
pricing initiatives
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Monitor/sustain performance over time
DUH Primary Hip
Direct Cost per Case
• Tableau tool housed
centrally
• Data updated monthly
• Targets set annually
• GPO peer cohorts as
benchmarks
• Data analytics expert
within CR program
maintains and
innovates
• Tableau tool
housed centrally
• Data updated
quarterly
• Testing different
approaches to risk-
adjust cost targets
• Collaboration with
Finance Director of
Clinical Decision
Support
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SupplySight serves surgeons, administrators, the procurement team,
and their interaction;
SupplySight incorporates timely, actual purchase pricing with surgical
usage; and
SupplySight provides drillable details; This builds tremendous
stakeholder trust.
SupplySight: Executive Summary
The following pages highlight real examples used during
discussions with surgeons in 2018
SAP
EPIC
DHTS
ADW
Perf Svc
Perf
Svc
DB
Data Structure
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Overview of Spine Program Savings
SupplySight was used to show the
impact of previous initiatives to
surgeons while discussing future
opportunities.
Surgeons saw that their average
spine implant cost per case
decreased roughly 20% from
January 2015 costs.
The dual-source agreement
reduced the number of vendors
and instrument trays.
Cost per Case
Vendor Share
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Cost Trend by Surgeon
MD
MD
MD
MD
MD
MD
MD
MD
MD
MD
MD
MD
MD
MD
MD
Seven of the ten surgeons with highest volumes have decreased avg spine supply cost
per case since Calendar Quarter 1 2015. [excludes revisions procedures, neurostim and biologic items, includes
accessories and niche] Jan15-Oct16 by Quarter; list sorted descending by number of cases
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MD A
MD B
MD C
MD A
MD B
MD C
$
$$
$
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$
$
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$
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Spine Procedure Spend Detail
SupplySight
allowed
surgeons to
compare
detailed
costs of truly
similar
procedures.
In this
example,
median case
costs vary
between
$4,300 and
$4,660 for 2
to 3 Segment
ACDFs.
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Creating the technology and data infrastructure to enable a clinically
integrated supply chain
Franco Sagliocca, Corporate Director, Supply Chain
Mount Sinai Health System
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MSHS Business Technology Mission
• Provide technology and analytics that support
Supply Chain’s provision of seamlessly coordinated
care to a diverse community, and the unrivaled
advancement of medicine through research.
Drive savings at the
pump, and at the bed-
side (utilization)
through a procure to
pay process that is
simple and efficient.
Cost
Source, and procure
superior
product/service
supported by supplier
in-servicing, and
support.
Quality
Source, and procure
product/service that
enables extraordinary
care.
Outcomes
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Architecture
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Our Plan
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Adoption Curve
